Eugenio G. Amparo

Magnetic Resonance Imaging after Closed Head Injury in Children

Magnetic resonance imaging (MRI) was performed in a series of 21 children and adolescents who had been hospitalized after sustaining closed head injuries of varying severity at least 6 months previously. Areas of high intensity in the parenchyma were present in 8 of the 11 severely injured patients, whereas MRI findings were normal in all 10 patients with mild-to-moderate head injuries. Lesions involving the subcortical white matter were confined to severely injured patients whose clinical features were compatible with diffuse axonal injury. Neuropsychological assessment disclosed deficits primarily in the severely injured patients; these deficits were significantly associated with persistent lesions visualized by MRI. Serial MRI and neurobehavioral assessment following early injury may be useful in documenting cognitive impairment in relation to structural alterations of the young brain.

MR imaging of uterine cervical carcinoma.

We retrospectively analyzed the magnetic resonance (MR) imaging findings of 20 consecutive patients with primary untreated carcinoma of the cervix who underwent surgery and one patient who underwent percutaneous needle biopsy of enlarged pelvic lymph nodes. Most of the patients were clinical Stage IB. The clinical assessment of the parametria in these patients was more accurate than the MR assessment of the parametria (95 versus 79%). Magnetic resonance was valuable for detecting metastatic pelvic lymphadenopathy. Enlarged pelvic lymph nodes (>1.5 cm in diameter) were demonstrated by MR in all three patients with histologic verification of metastatic lymphadenopathy. In summary, the major therapeutic value of MR in patients with untreated cervical carcinoma is in assessing the pelvic lymph nodes. In patients with clinical Stage IB disease. MR assessment of the parametria does not add useful additional information.

Primary diagnosis of abdominal arteriovenous fistula by MR imaging.

Two cases of abdominal arteriovenous (AV) fistula were imaged by magnetic resonance (MR). Magnetic resonance imaging showed abnormally increased flow with resultant dilatation of the veins draining the site of the fistula. Findings were correlated with CT, digital subtraction angiography, and arteriography. This report suggests the usefulness of MR imaging as the initial imaging technique of choice in clinically suspected cases of AV fistula. The diagnosis can be made within 30 to 45 min of imaging time and does not require administration of contrast material.

Traumatic Diaphragmatic Hernia into the Pericardium: Verification of Diagnosis by Computed Tomography

Computed tomography (CT) is a useful modality in the evaluation of mediastinal abnormalities and in the assessment of mediastinal masses for fat content. A case of posttraumatic herniation of the omentum and large bowel into the pericardial sac is presented. The mediastinal configuration, depicted on a CT scan, is thought to be diagnostic of this extremely rare abnormality.

MR imaging of mediastinal pseudocyst.

Magnetic resonance imaging of a mediastinal pseudocyst clearly demonstrated the entirely intrathoracic location of the pseudocyst.

Intramural hemorrhage simulating gastric neoplasm

We report a case of benign gastric ulcer with secondary extensive intramural hemorrhage causing a radiographic appearance consistent with a large ulcerated gastric neoplasm. This is the second such case reported and the first studied with sonography and computed tomographic scan. A brief review of the literature on intramural gastric hematoma is presented.

MR imaging of orbital blow-out fractures.

We report on a case of orbital blow-out fractures involving the medial and inferior walls. In this case conventional multiplanar 8 mm thick sections with magnetic resonance (MR) imaging proved to be more helpful than 1.5 mm axial thin sections with CT in demonstrating the extent of orbital floor herniation of fat. Entrapment of muscle was excluded. Oblique sagittal views were most helpful in evaluating the orbital floor, since the full course of the inferior rectus muscle is seen. Additionally, the optic nerve is seen along its entire length. Masking of intraorbital contents by isodense hemorrhage on CT studies apparently is not a problem with MR imaging if hemorrhage is small or nonacute.

Mr Demonstration of Extensive Pelvic Involvement in Vulvar Hemangiomas

Magnetic resonance imaging of two patients with vulvar hemangiomas noninvasively demonstrated unexpected pelvic involvement. Magnetic resonance is an excellent method for initial evaluation and follow-up of these lesions.

Normal in vivo eye dimensions by computed tomography.

In Win measurements of the eye were obtained in 55 normal adults using computed tomography. Means and standard deviations were established for the maximum transverse and the maximum anteroposterior dimensions. Our data indicate that the widely used methods of Sweet and Pfeiffer-Comberg (for intraorbital foreign body localization) underestimate the actual in vivo dimensions of the eye.

Case report 466

Fig. l A D . Plain films showed soft tissue swelling of the proximal phalanx of the left 3rd finger. A Sagittal SE 500/38 and B Sagittal SE i500/38 MR images of the left middle finger. The imaging plane is slightly oblique to the long axis of the finger. The flexor tendons (white arrowheads) are seen coursing through a mass (m, Fig. B) within the flexor tendon sheath (black arrow) (Fig. B) of the middle finger (h = head of the third metacarpal bone (Fig. A and B.). C Artist~s rendition of A and B. The shaded area represents the mass within the tendon sheath. D Axial SE 900/38 MR image at the level of the distal end of the 3rd metacarpal demonstrates the mass (m) and tendons (white arrowhead) within the tendon sheath (white arrow)